يتناول هذا البروتوكول إدارة اعتلال حجاج غريفز في مرحلته النشطة الخفيفة — عندما لا تؤثر مظاهر المرض إلا تأثيراً طفيفاً على الحياة اليومية ولا تستدعي بعد التدخل بالمثبطات المناعية أو الجراحة.
المرض نشط (مقياس النشاط السريري ≥3/7) لكن شدته محدودة. تشمل المظاهر النموذجية:
تتمثل الأهداف الأساسية في تحسين مقياس النشاط السريري ودرجات جودة الحياة (GO-QOL) خلال 6 أشهر، وتقليل احتمالية تطور المرض.
Patients whose features of TED have only a minor impact on daily life insufficient to justify immunosuppressive or surgical treatment.
They usually have only one or more of the following: minor lid retraction (<2 mm), mild soft tissue involvement, proptosis <3 mm above normal for race and sex, transient or no diplopia, and corneal exposure responsive to lubricants.
Local and lifestyle measures and watchful monitoring will be sufficient in the majority of patients with mild disease, which in due course will remit completely or partially.
A single course of selenium selenite 100 µg twice daily for 6 months may be considered for patients with mild, active TED, particularly in regions of selenium insufficiency.
In patients with symptomatic inflammatory soft tissue involvement or if radioactive iodine is used (oral glucocorticoids prophylaxis).
After 6 months of therapy, improvements in CAS as well as in GO-QOL scores were noted with selenium therapy, but not with placebo, and persisted for an additional six months after therapy was stopped.
Overall, patients treated with selenium were more likely to have improvements in their TED, and less likely to have disease progression.
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